One of the largest sources of commentary on the Mental Help Net website in the past months has been due to a series of articles having to do with men's anxiety over their small penis size. In the original articles, An Anxiety Disorder: Small Penis Syndrome, and Male Self Concept and Small Penis Syndrome, Dr. Schwartz's premises was that in many cases, men's penises were not as small as they thought they were, or as unacceptable. A literally outpouring of responses followed which, for the most part, were angry and in opposition to the implication that the perception of having a small penis was a psychological problem more than a physical one. Attempts made by Drs. Schwartz or Dombeck to clarify the issue were largely met with skepticism or rejection.

This spirited discussion was not something we anticipated when the first article on the topic was published. In responding to the ongoing discussion we have struggled to better understand the mindset of the men who complain about this issue which goes by the label, "Small Penis Syndrome". In the current essay, we want to present our working understanding of the psychology behind Small Penis Syndrome, and we want to talk about what men who are dealing with this issue can do to help themselves to feel better. What we have to say about these men comes from our observations of the comments they have left in response to Dr. Schwartz's essays, and some of the interactions that have occurred therein. In making statements about the psychology of an entire group of men we will be drawing a sort of caricature or composite image; something that describes issues this group of men faces in the broad sense, but maybe doesn't perfectly fit any individual case. We know this, and don't want anyone to feel that every thing we say here must specifically apply to them.

Characteristics of Men with Small Penis Syndrome

The men who self-identify as having a small penis that affects their lives in substantively negative ways and who have commented to this effect on Mental Help Net tend to share characteristics in common

A certain psychological rigidity, obsessionality or fixation is present. These men are absolutely adamant in their conviction that their genitalia are too small. They insist that they have measured themselves and seem inordinately focused on such measurement. They are similarly convinced that they are incapable of pleasing a woman via intercourse, although they are, by and large, not able to cite much evidence to show that this is true. In fact, many of these men admit to having had few or no sexual experiences. There is an implication that some of the few sexual experiences had by some of these men were with prostitutes. Many may have had only a single sexual encounter. Others state that they avoid sexuality entirely as they feel deeply ashamed of their penis size. All of these men affirm the belief that women would universally treat them with contempt if they were to see them nude.

These men with Small Penis Syndrome are very much focused and fixated on women and what women want or don't want. They seem to view females as ridiculing, castrating, powerful and "goddess like". The "goddess" energy that is attributed to women is less the positive sexuality of an Aphrodite, however, and more the devouring energy of a Kali. The classical image of the "Vagina Dentata" (the mythic toothed vagina that can bite your penis off) comes to mind.

A Variety of Anxiety Disorder

This highly idealized and unrealistically threatening view of "all women" (at least of "all women" who are potential sexual partners), and the associated avoidance behavior and consequent lack of actual peer relationships with women when such relationships are longed for so achingly is consistent with the idea that Small Penis Syndrome involves, in some cases, a variety of anxiety disorder along the lines of Social Phobia (Social Anxiety Disorder). These men engage in avoidance behavior and express deep and fundamental fears about their appearance, ability to perform sexually, and their social adequacy. This fear is further perpetuated by very distorted thinking about women and sexuality.

The anxiety and shame and lack of actual relationship experience characteristic of men with Small Penis Syndrome leads them to feel hopeless and depressed and in some cases, suicidal. This much is clear from statements within comments some of these men have left concerning how they feel miserable and wish to die.

The cognitive rigidity present in mens comments is consistent with the idea that an anxiety disorder or depressive issue is present. These men display prominent cognitive biases in that they easily accept information that tends to confirm their perception of self as inadequate, but reject information that is contrary to their convictions. Only data that convinces them of the smallness of their size and the hopelessness of their existential position is taken seriously and accepted as fact. Our attempts to argue points of fact with these men were adamantly rejected, and we were more than once accused of holding out false hope when we claimed that having a small penis did not have to be the end of the world.

Possibly: Developmental Delay and Inverted Narcissism

Small penis syndrome may be describing something more than simple anxiety and depression issues in some cases. The degree of rigidity of beliefs about the penis and about the rejecting nature of women is very high in some of these men, suggesting something akin to a personality disorder, or, more simply, a developmental delay that some of these men may have experienced in terms of their social maturity, perhaps as a consequence of the trauma of their shame over their small penis. It appears that in some cases, these men's view of women remains cast in the relationship of boy to mother (or, if you prefer, worshiper to goddess), rather than adult man to adult woman. There is little sense of these men believing they are in peer relationships with women.

We have come up with the term "Inverted Narcissism" in our attempts to try to characterize the nature of the developmental delay we've perceived occurring in Small Penis Syndrome. To understand what we mean by inverted narcissism, it is first important to understand the psychological term "narcissism".

Fundamentally, narcissism refers to a person's excessive interest in their self and in the way they look. The narcissist displays a grandiose way of thinking about their own talents, beauty, masculinity or femininity and intelligence. While they have an inflated sense of self-worth, they are generally devaluing and dismissive of others. In fact, to the narcissist, other people are generally not treated as peers, but instead as mere objects to be exploited for selfish motives. A very clear example of a male narcissist would be the "Casanova" who promises women everything in order to exploit them for sexual favors and who abandons them after having gotten what he wants from them.

Inverted Narcissism is a form of narcissism where the roles of exploited and exploiter are reversed from their classical position. The inverted narcissist views himself as nothing more than an object - in this case a penis - to be exploited by others. Other people - in this case potential sexual partners - are seen as all powerful, beautiful, exploiting and derisive. Women are believed to want nothing from a man except a large penis. Women, always cruel and capricious in this view, will abandon men if their penis fails to satisfy. Women will reject any man with a small penis in the most derisive way possible.

In trying to understand the psychology of Small Penis Syndrome, we have had to grapple with the question of what constitutes a small penis. Most of the men who have written us have supplied their penis measurements (it is a habit of such men to do so). When we have compared such measurements against the few scientifically constructed sampling distributions of male penis size we've found what we've often noted is that the penises of the men writing to us are within the average range of penis size (length anyway) when considered statistically (e.g., plus or minus one standard deviation). They have been on the minus side in many cases, but still within this area of central tendency. Other men have written to us with penises that are smaller than that, but still generally within two standard deviations. When we have tried to point this out, we've been told that our sampling distribution reference points were smaller than the "true" average. Informal websites such as www.sizesurvey.com with it's impressive but self-selected sampling distribution of penis sizes are preferred as reference points, and of course the average penis size recorded within these preferred reference points is always larger than anything that has been constructed according to scientifically rigorous standards.

We don't know what the true population penis size is; we can only estimate based on samples. The controversy over which samples to use, with us favoring samples that appeared to have been better constructed but with smaller sample sizes and smaller average penis lengths and the readers favoring samples showing the largest average lengths got us thinking, however. How could we or anyone know when someone actually has a small penis versus a case where the person's penis is actually (truly) average sized (if on the minus side of average) but firmly believes themselves to be small because that person is comparing against a biased sample. And when, if ever, do people cross the line into Body Dysmorphic Disorder (BDD)?

Body Dysmorphic Disorder is a condition where a consistent perceptual distortion exists (a delusion if you will) that the body or a part of the body is larger or smaller than it actually is. While BDD is usually identified with anorexia and other eating disorders, it appears to be relevant to this preoccupation with penis size as well. It appears to us that some men have perfectly adequate penises (based on the measurements they've communicated. These penises are not going to break any world records, but they are probably just fine, however, these men are firmly convinced that they are hopelessly inadequately small. There is a question as to whether this scenario is an example of BDD. In other words, do these men: A) have a perceptual delusion in which the self is seen as small when self is really average or, B) do these men represent cases where even the average man is seen as small, based on a belief that no truly average man could possibly satisfy any women? "B" is probably not BDD as this isn't necessarily a perceptual distortion. Instead, "B" may be a distortion of the "reference point" against which the body is compared, rather than a distortion of perception of the body's size. "Reference point" refers to reported penis measurements reported in various published and available on the Internet, and in the form of pornography (e.g., in comparison with male porn stars who have large penises).

Further Observations

Beyond the Social Anxiety, Depression, hopelessness, cognitive rigidity, suicidality, possible social maturity developmental issues and the possibility of whether a Body Dysmorphic Disorder type issue is playing out for some of these men, there are a few other observations we can make.

These men are angry. They are angry with themselves (expressed as self hatred and depression), and with women. They are angry, in some cases, at the world. They maybe view themselves as being in a similar situation to the tortured one that the mythic figure Tantalus found himself in. Tantalus was punished by the gods by being immersed in water he could not drink, and being nearby a fruit tree whose boughs would blow away from his hand when he grasped at fruit. Tantalus was starving and thirsty in the midst of apparent plenty. Similarly, men with Small Penis Syndrome are surrounded by attractive women they can NEVER EVER EVER (so they think) hope to impress.

These men are distrustful. They do not trust that any woman would ever tell them the truth. If a women were to say, honestly, that she found them attractive and a good lover, they would think that she was lying to make them feel better. It is impossible in the mindset of some of these men to conceive of the idea that a woman could ever accept them. When acceptance is actually offered, it is so dissonant with this conviction that it is just dismissed as an obvious lie.

These men are focused almost entirely upon how to please a woman rather than how a woman could please them. This is consistent with the idea that Social Phobia (Social Anxiety Disorder) is present, and with the idea of inverted narcissism. More fundamentally, these men do not believe that they are or ever could be adequate sexually. They are sure that engaging in foreplay could somewhat gratify a woman but penetration will necessarily end in failure because their penis is not "big enough". And, of course, they seem to believe that all women demand penetration; that it is not possible for women to have a satisfying sexual experience without penetration. This is, of course, not true as many women are perfectly capable of achieving orgasm manually/digitally.

How To Help?

There is no medical procedure that we know of that can reliably and safely enlarge a small penis. For us, as psychotherapists, the question becomes, "Given that I have this problem that cannot be fixed, what can I do to reduce its impact on myself so that I can live a happier life?". Our thoughts about how to answer this question follow. While these suggestions are intended as useful aids to all men, they might be especially helpful to the men who are extremely angry, hopeless and depressed because they are convinced that they are not well enough endowed.

Identify and Correct Cognitive Distortions

Cognitive therapy and appraisal theory have taught us that how we think about and judge situations causes and shapes our emotional reactions to those situations. We do not become anxious about a situation unless that situation feels threatening to us. Not all situations that feel threatening actually are, however. And not all threats are actually all that dangerous either. In the case of Small Penis Syndrome, it seems to us that there are common habits of thought and common beliefs frequently present that are not necessary and which make the situation more difficult and painful than it has to be. By identifying what those thought habits and beliefs are and taking steps to correct them, a fair amount of the pain and difficulty of this issue can likely be avoided.

The most important thought habits to watch out for are rigidity, over-certainty, and a tendency to over-generalize. As we've pointed out, men with Small Penis Syndrome tend to fixate on the idea that they are hopelessly inadequate, that all women will reject them, that all women are lying if they don't reject them, etc. There is no room to move from this position, and yet these beliefs, in their rigid over-certainty simply cannot be true in all cases. No real work on cognitive biases and faulty beliefs can occur until these men become aware and accept that they might just be wrong in some cases.

It is important for men bothered by the size of their penis to identify and correct any distorted beliefs they may have regarding their small penis. An important first step is simply identifying whether one's penis is actually small in the first place. Answering that question gets directly to the concept of reference points; that which you are comparing your penis against. There are two kinds of reference points that matter here; those that reflect the average penis size in the community (e.g., sampling distributions), and the honest acceptance of a person's body by that person's lover. In our estimation, the latter is far more important than the former. If someone cares for you and accepts you as you are, with all the imperfections that plague most human bodies, then it doesn't matter so much how you stack up against other people.

Reference Points: Testimony versus Statistics:

In using reference points in deciding that one's penis is small, there are at least two types of data you can compare yourself against. One is testimony from women and the other is statistical data (sampling distributions) derived from various research studies on this topic. By women's testimony we mean stories and articles published by women in magazines and on the Internet and the like. We also mean women's behavior (particularly rejecting behavior) that men may have encountered directly in the course of their lives. In the case of one example blog that was pointed out to us, a woman gushed about how much she enjoyed intercourse with men who have large penises and wrote about this pleasure in such a manner as to suggest that normally she lies about this to her partners and does not tell them the truth about her preferences.

When trying to decide whether to compare one's self against a sampling distribution or against the negative testimony of a few women, it is almost always a better idea to prefer the sampling distribution. There are a number of reasons why this is the case. Two prominent reasons are that that many more people's information is typically represented in a sampling distribution than in the testimony of a few women, and that typically sampling distributions are more representative of the true nature of the population than are the opinions or observations of a few women.

A third reason to avoid testimony when possible is that it is so often used to manipulate people for commercial reasons. For example, stories appearing in magazines and blogs can be distorted and sensationalized simply because doing so will tend to attract more attention and thus more advertising dollars. Commercial testimonies, such as found in popular magazine stories and on blogs, and in email spam pitches for "penis patches" are not always representative of the true nature of the population because they are conceived with the idea of selling stuff.

This is not a perfect rule (to trust sampling distributions and to avoid reacting to testimony); sampling distributions can be badly constructed and contain bias themselves. However, if a sampling distribution has been well constructed (in the course of a scientific study) it will have been created using methods that try to reduce the possibilities for bias such as random sampling techniques, and it will contain a lot of people's information, which tends to dilute the influence of a few people with strong opinions one way or another who would otherwise stand out like sore thumbs in a tiny sample. The worst thing you can do is to feel inadequate after reading a cruel blog entry, as the opinion of one woman is never representative of what all women believe.

The Need for Statistical Education

The men who have written us about their small penises who have compared themselves against statistical data have not always been careful about which data sets they have chosen to compare themselves against, and in some cases have made statistical errors such as failing to take into account the "cloudy" or probabilistic nature of sampling distributions as they came to their conclusions. It is possible that this tendency towards misinterpretation is due to a lack of knowledge about statistics and/or proper research design techniques, neither of which are widely taught subjects.

It is entirely possible that some men could help themselves by taking classes in statistics so as to learn about concepts like standard deviation and standard error - measures of the spread around the mean and the error or "noise" inherent in the measurement process - so as to better understand that an average penis length is not really a single number as it appears to be, but rather a range of numbers plus and minus around that point. We also think that it could be helpful for some men to read up on how sampling distributions and surveys can be constructed so as to avoid sampling biases (e.g., with random sampling and consistent measurement processes) so that they can better appreciate why samples which have been constructed in a self-selected basis (e.g., such as www.sizesurvey.com where the only people represented there are people who took the effort to find the website in the first place, measure their own penis, and send in the data) are not generally the most reliable samples.

The Need for Real World Experience

In light of the fact that many of the men discussed in this essay report few sexual encounters with women, it is important to recognize the need for real world experiences in the area of sexuality and relating to women. In other words, these men need to get out and date; to talk to women and listen to what they have to say. Men need to be careful to avoid dismissing what they are hearing from the women they spend time with when what they hear disagrees with their preconceived notions. Finally, a variety of experiences with different women might help these men better appreciate the variety and types of women who are actually out there. In essence, we are recommending a form of exposure therapy. Only through direct experience will these men be able to learn that women are not all castrating and hostile, or dominantly focused on penis size when it comes to sexuality.

We do not mean to be flip about making this recommendation. We understand that there is a tremendous fear of rejection, and that actual social phobia may be present. We understand that a lot of anxiety is likely to be present which will interfere with the process of dating or just talking. Nevertheless, getting out there is going to be an absolutely vital part of working this issue through. You cannot appreciate that you've made a mistake by avoiding all women until you've taken the risk to talk to many women and have experienced first hand that many of them will not reject you. As this process of dating can be difficult for people who are very anxious about it, we recommend that professional help be sought. The best type of therapy for social anxiety is Cognitive Behavioral Therapy (CBT). Cognitive Behavioral Therapy helps people to identify and correct thought distortions and biases, teaches self-assertion (to help men better persevere in the dating process) and assists socially anxious men in coping with those rejections which will inevitably occur (regardless of penis size), among other helpful outcomes.

Put Pornography in Perspective

Our hunch is that some of the distorted ways of thinking about male and female sexuality that manifest in Small Penis Syndrome may stem from the fact that many of the men who have this problem have exposed themselves to a lot of pornography. One of the many problems related to pornography is that it misrepresent what human sexuality is about; replacing intimacy and love with simple and raw sex. It also tends to be populated by male actors with larger than average genitalia who aren't shy about using enhancement drugs to prolong the size and duration of their erections. There are a lot of sexual behaviors (such as anal sex) that are far more common in pornography than in the regular world. It is certainly the dominant attitude within pornography that when it comes to penis size, bigger is always better. That is not necessarily always the case in the regular world. Without condeming pornography, which seems to have its firmly fixed place in society, we want to make clear to men with Small Penis Syndrome that it is vital to recognize that these biases and distortions exist in pornography, and that it is not wise to apply the standards of beauty and performance and the value systems present pornography to your own life. Anyone who tries to do so will likely feel incompetent.

Because porn is unable or unwilling to film lovemaking (intimate sex), men who get most of their sexual education from porn fail to realize that for many many men and women, the actual act of sexuality is ultimately valued less for its capacity to create an orgasm, and more for the intimacy to be found therein. This becomes more the case, we suspect, as people get older, but it is true for a great many young people as well. We recommend that men who watch a lot of porn and who suspect that they may be suffering in part because of this take an adult sex education class so as to help them gain a better perspective on what normal sexuality is actually about.

When rigidity of thought is high, as seems to be the case with some frequency with regard to Small Penis Syndrome, it is very difficult for people to seriously entertain the possibility that they may be contributing to their own problems through cognitive biases and honest mistakes regarding statistics and the like. It seems all too clear to such people that they are doomed; that they can never be an acceptable man to any acceptable woman, and that because of this, they might just as well commit suicide. To such people we say, don't bother with the advice we've given above. What you need to do is to work on what we might term self-acceptance and detachment coping strategies. You are so embedded in the problem that you have no perspective on it from which to constructively criticize it. What is needed for you is to help you pry yourself out of the problem enough to give you that room to maneuver

Mindfulness meditation is one of the most powerful and safest techniques available to help people disembed themselves from cognitive prison (in the 1960s authors like Leary and Huxley recommended LSD for this same purpose, but we are far more sober now). In mindfulness meditation you learn to simply become aware of the continual stream of thoughts, perception and judgments that flow through your mind, and you learn that you are are not the same thing as the content of those thoughts, but rather that which has the thoughts. This is sometimes called the "witness" consciousness. It is a non-judgmental mental space that can be cultivated by anyone. In the embedded state, the thought-haver and the thought are fused, but mindfulness meditation helps open a space between the haver and the thought. Mindfulness meditation is originally part of an ancient religious tradition originated by Buddhists and going back thousands of years. Today it is being incorporated into western mainstream psychotherapy as an effective coping strategy for helping people cope with life stress and extreme emotional mood swings. As you learn to detach yourself and take up the witness consciousness, you become able to view your thoughts more objectively and ultimately gain a better ability to critically examine them.

It is hoped that people will find this essay helpful. Comments are always welcome and encouraged.

Editor's Note: August 3rd, 2009: Several days ago, after watching a disturbing trend of angry comments start to bloom into outright advocacy of aggression (something we could not allow), we decided to turn off comments on our series of Small Penis Syndrome (SPS) articles. We regret that it has come to this as we have become amply aware that it is important that people have a place to go on the Internet where they can talk about this powerful anxiety and the shame that surrounds it. Today, we are restoring read-access to the older comments, but are not going to accept any new comments on the essays themselves.

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